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The Gerontologist 48:223-234 (2008)
© 2008 The Gerontological Society of America

A Multidimensional Approach to Understanding Under-Eating in Homebound Older Adults: The Importance of Social Factors

Julie L. Locher, PhD1,2,3,4, Christine S. Ritchie, MD1,2,5,6, Caroline O. Robinson, MA3, David L. Roth, PhD7, Delia Smith West, PhD8 and Kathryn L. Burgio, PhD1,2,5

Correspondence: Address correspondence to Julie L. Locher, PhD, CH19, Room 219, 1530 3rd Avenue South, Birmingham, AL 35294-2041. E-mail: jlocher{at}

Purpose: The purpose of this study was to identify relationships between medical, functional, economic, oral health, social, religious, and psychological factors and under-eating in homebound older adults. The focus of the study was on identifying potentially modifiable factors amenable to social and behavioral interventions. Design and Methods: A total of 230 homebound older adults who were currently receiving home health services participated in interviews in their homes using a questionnaire to assess eating behaviors and factors that could possibly affect those eating behaviors. Interviewers measured height and weight, and participants completed three 24-hr dietary recalls. Results: The mean age of participants was 79.1 years. The sample comprised 78% women and 38% African Americans. We found that 70% of participants were under-eating, defined as not consuming enough calories to maintain their current body weight. Participants who were at higher risk of under-eating included men, those receiving either infrequent care or very frequent care by a caregiver, those who had been hospitalized prior to receipt of home health services, and those with a higher body mass index. Implications: Findings from the study have implications for both practice and policy. Experts must develop evidence-based interventions targeted at under-eating in this particularly vulnerable and growing population of homebound older adults. This study provides an initial foundation for the development of targeted evidence-based behavioral nutritional interventions that are noninvasive and cost effective.

Key Words: Under-eating • Undernutrition • Nutrition policy

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2008 by The Gerontological Society of America.